28 October 2007

The Kaiser And The Pope

People who get health care from Kaiser Permanente in metro Denver are at risk of taking orders on health care from the Pope starting in 2008.

Sisters of Charity of Leavenworth Health System prepares to take over Exempla Healthcare's St. Joseph Hospital in Denver, Lutheran Medical Center in Wheat Ridge and Good Samaritan Medical Center in Lafayette. Sisters of Charity is paying $311 million to buy out the 50 percent stake of its partner in the hospitals, the Community First Foundation.

At the time the agreement was announced in December, Exempla and the foundation said they would try to find a third party to provide reproductive services, such as abortions and birth control, which are banned by the Catholic church's ethical and religious directives. But this week both sides said they wouldn't reach an agreement to provide such services, prompting Exempla's board to oppose the deal. . . .

Kaiser, one of the state's largest insurers with about 480,000 subscribers, funnels most of its Denver members to Exempla's hospitals. St. Joseph, owned outright by the Sisters of Charity, is already run according to Catholic tenets, but Good Samaritan and Lutheran will stop offering reproductive services if the deal is completed.

Kaiser's regional president, Donna Lynne, said the insurer has been working with Exempla to develop a plan for Kaiser members to receive care for the services that would no longer be available, but "at this time we have not finalized a plan that we believe fully meets the needs of our members." . . . Sisters of Charity said it expects to complete [the ownership change] by year-end[.] . . .

The first part of the attorney general's review [required to approve the deal] centers on whether Sisters of Charity's complete ownership of Exempla will result in a "material change in purpose" for the charitable organization . . . . Sisters of Charity and the Foundation said an analysis shows there is "more than adequate" access to these procedures elsewhere in the community. Exempla's board, however, plans to write a letter stating the transfer would cause a reduction of services. . . .

Exempla agreed to the ownership change last year, in part because . . . Sisters of Charity agreed to invest at least $300 million in the Exempla hospital, in addition to the $311 million it is paying to the foundation.

Attorney General Suthers, a conservative Republican elected official, will make the call (subject to deferential court review) on whether this deal passes muster.

The fate of the deal also impacts the future development plans of all three hospitals and the former Children's Hospital site downtown.

What is the status quo?

At St. Joseph, only indirect abortions - defined as treating the clinical illness of the mother to preserve her life, knowing the fetus could be lost - are allowed. Women requesting emergency contraceptives are referred to nearby hospitals or medical centers.

Doctors at Lutheran and Good Samaritan, meanwhile, provide women with information and the option of emergency contraceptives if they have been raped.

Abortions are performed but only very rarely, at an average of five a year at both hospitals combined. Most abortions are to preserve the life and health of the mother . . . [Often] women opt to get tubal ligations after giving birth via Caesarean sections. At Catholic-run facilities, that sterilization treatment must be performed elsewhere at another time, meaning another major abdominal surgery and finding child care. . .

In September, the Vatican declared that vegetative patients have a moral right to feeding tubes, which some observers felt was a shift toward a more restrictive policy on feeding tube use for patients who have no hope of regaining consciousness.

This is a high price to pay for $200 a month less in premiums. To be clear, Kaiser Permanente isn't the instigator in this case. It had a status quo that provided health care choices to members, although only by leaving Denver to get them. Kaiser is in this position simply because it has a very small network of health care providers, which its business model seems to require to get competitive rates. But, it remains to be seen if Exempla and Kaiser are going to sell its customers down the river for $300 million from the Sisters of Charity. The likelihood that this issue was going to come up should have been obvious when the deal was signed and it is disappointing to see players like Exempla and Kaiser wake up to the consequences of their deal only now.